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Vanessa Bowlin, Sandeep Samudre, Deepinder Dhaliwal; Longitudinal Mixed Effect OSDI Model in a Select Dry Eye Patient Population after Acupuncture Treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4356.
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© ARVO (1962-2015); The Authors (2016-present)
Keratoconjunctivitis sicca (KCS) is a common multifactorial disorder that negatively impacts a patient’s quality of life, quality of vision, and ocular surface. Prior studies have documented beneficial effects of acupuncture for treatment of KCS. Modeling this behavior could facilitate better understanding of acupuncture mechanism of action and KCS. This retrospective study evaluates the ocular surface disease index (OSDI) in dry eye patients who received acupuncture treatment.
In this retrospective study, OSDI data from 49 dry eye patients randomly assigned to either true or sham acupuncture treatment group was re-evaluated. Participants had received two treatments and were followed at regular intervals for period of 6 months. Linear mixed effect model included: Treatment (tx), actual time (atime), square of actual time (atime^2), centered age (agec), sex, and the following interaction terms: tx*atime, agec*atime, agec*atime^2, sex*atime, sex*atime^2. Potential confounders such as age and sex were also included in the model.
After 6 months, OSDI was significantly reduced from a baseline of 34 ± 3 to 16 ± 4 (p= 0.01). The final linear mixed model equation for OSDI = 29.39 - 7.39*tx + 0.530*agec + 35.50*sex + (-0.292 + 0.0858*tx + 0.133*sex + 0.00849*agec)*atime + (0.00103 - 0.00118*sex - 0.00005*agec)*atime^2 + random slope of atime + random error. This equation also reported an immediate and rapid improvement in OSDI scores in patients receiving true acupuncture treatment. No significant differences in OSDI were observed after sham acupuncture treatment (p=0.09). Also, there were no adverse effects reported.
The study demonstrated that acupuncture improves symptoms in dry eye sufferers evaluated by OSDI. It is possible to model dry eye behavior using a linear mixed effect model. Modeling this behavior facilitates understanding of KCS and acupuncture, which can be a useful complement to KCS treatment modalities.
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